Rhinoplasty is the most complicated operation in facial plastic surgery. Thus it is no surprise that nose surgery has one of the highest revision and complication rates of any facial plastic surgery operation. Because revision rhinoplasty seeks to correct problems created by a previous procedure, the surgeon and patient must have a clear understanding of the nature of the complications created from the original operation.

Due to the vast breadth of approaches and techniques that may have been used in the earlier nose surgery, a broad range of problems for which one may seek corrective procedures exist.

Patients who seek revision rhinoplasty may have any number of cosmetic complaints and nasal breathing difficulties. Small asymmetries or irregularities may occur as the result of minor errors of technique. These problems are relatively straightforward and more easily corrected than more serious problems. Large asymmetries, functional obstruction, and gross deformities are more likely to result from errors of judgment or lack of experience.

When Dr. Kim meets with a prospective revision rhinoplasty patient at his office in San Francisco, it is crucial that they discuss in detail the problems that led to the patient’s visit. Previous operative notes, rhinoplasty diagrams, and pre-operative and post-operative photographs may help in determining the nature and time ¬-course of the problems. Photographs may also reveal which problems resulted from the nose surgery and which problems predated the original surgery.

A thorough physical examination inspecting the state of the soft tissue covering and skin, the nasal cartilages, bones, and internal structures of the nose is critical. Based on all of this information, the patient and physician should prioritize goals and gauge how reasonable and achievable these requests are.

As with primary rhinoplasty, the use of photography and computer assisted imaging may be of great help in the discussion of cosmetic goals. Each specific problem should be discussed with regard to possible cause and prospects for repair.

In many cases, revision rhinoplasty patients suffer from some nasal breathing problems caused by previous nose surgery as well. Pinching or collapse of the external nose during breathing suggests that reductive surgery has led to narrowing and/or weakening of those structures in the nose that maintain breathing. Inspection inside the nose with a small endoscope may be helpful in determining the nature of the breathing problem.

Understandably, revision rhinoplasty patients have already undergone a period of disappointment regarding the appearance and/or function of their nose after surgery. They may have invested considerable energy and effort in considering revision surgery. Patients should understand that the greater the degree of baseline damage, the more limited will be the possibilities for improvement.

In many situations it is not possible for Dr. Kim to fully understand the extent of damage in the nose until exposure is gained during surgery. As such, it is not always possible to outline every detail of the revision surgery and expected outcome pre-operatively. As with all surgical procedures, revision, cosmetic and functional nose surgery should not be performed unless common expectations can be generally reached between patient and surgeon.

The main complications of revision rhinoplasty are the same as in primary rhinoplasty. However, the risks of these complications occurring may be higher, depending on the severity of the problems being addressed. In particular, if there has been damage, thinning, or infection of the skin and soft tissue covering of the nose, there will be a higher risk of skin injury during revision rhinoplasty. Such injuries can lead to visible scar formation, pigmentation of the skin, or contour irregularities, especially at the tip and base of the nose. This is why it is so important to choose a facial plastic surgeon who is highly experienced to perform any procedure including rhinoplasty.

See more before and after photos of rhinoplasty by David W. Kim, MD.

Dr. David Kim is widely regarded as one of the top rhinoplasty surgeons in the United States. If you have been considering revision nose surgery, contact his practice today at 415-773-0800 to schedule your comprehensive consultation.